Chapter 4: Intake
The intake process includes the initial face-to-face visit with the family and the start of information gathering for eligibility determination. This initial visit between the service coordinator and the family provides the opportunity to welcome and get to know the family, further describe the Infant & Toddler Connection system (which was introduced in the phone call with the family to schedule the visit), and discuss the options and opportunities available to them through the system. At the point of intake, the local Infant & Toddler Connection system is already beginning to provide supports and services to the family by sharing tips and information on child development and/or parenting and by providing referrals to other resources, as appropriate and with parent consent.
The Intake Visit (The Initial Face-to-Face Visit):
Service Coordinator Responsibilities:
1. Meet with the family in order to share information about the Infant & Toddler Connection system. All families receive consistent information about the Infant & Toddler Connection system using the outline of topics in the box on the next page.
2. Fully inform the family about their rights, responsibilities and procedural safeguards under Part C and complete necessary paperwork (if not already addressed during phone or other contact prior to the intake visit). Emphasize the rights and safeguards applicable to the screening and eligibility determination steps in the early intervention process.
a. Ensure that copies and explanations of procedural safeguard forms are provided in the family’s native language or other mode of communication unless clearly not feasible to do so.
b. Provide a copy and explanation of Notice of Child and Family Rights and Safeguards Including Facts About Family Cost Share in the Infant and Toddler Connection of Virginia Part C Early Intervention System and Strengthening Partnerships: A Guide to Family Rights and Safeguards in the Infant & Toddler Connection of Virginia Part C Early Intervention System.
c. Point out where information related to storage, disclosure, accessing and correcting of personally identifiable information is included in the Notice of Child and Family Rights and Safeguards in the Infant and Toddler Connection of Virginia Part C Early Intervention System Including Facts About Family Cost Share.
d. Obtain informed, written parental consent to proceed to screening (if needed) and/or eligibility determination using the Notice and Consent to Determine Eligibility form, marking the appropriate consent statement(s) at the bottom of the form to indicate whether the family is giving consent for developmental screening, hearing and vision screening and/or eligibility determination. In some situations (e.g., when eligibility can be established by records or when the family wishes to combine eligibility determination with assessment for service planning), it also will be appropriate to obtain informed written consent to proceed to assessment for service planning using the Notice and Consent for Assessment for Service Planning form.
e. Since the financial intake must be completed prior to IFSP development, if the family wishes to combine eligibility determination with the assessment for service planning (and potentially the IFSP meeting) or will be proceeding directly to assessment for service planning combined with an IFSP meeting, and the Family Cost Share Agreement form has not already been completed, then talk with the family about completing the financial intake prior to the combined activities to ensure the financial information can be discussed privately. Situations in which this might be appropriate are further described later in this chapter.
f. Obtain parent signature on release of information forms in order to obtain existing screening, medical, or other information to assist in determination of eligibility. If the family does not consent to this release of information, explain to the family the impact of their decision to refuse consent for the release of information, including why consent is needed, how the information will be used, and how the absence of that information may affect eligibility determination.
g. Obtain parent consent to contact the referring agency/provider and the child’s primary medical care provider to inform them of the child’s status in the Part C system, if consent was not already obtained by the referral source and/or primary medical care provider.
h. If the child has Medicaid/FAMIS:
· Ensure completion of the Family Cost Share Agreement form at intake (See instructions in Chapter 11). This step is necessary in order to begin billing for Early Intervention Targeted Case Management (EI TCM) at intake and to ensure Medicaid reimbursement for all reimbursable services, including assessment for service planning if the child is eligible.
· Obtain the child’s Medicaid/FAMIS number and enter it into ITOTS within 10 business days of the intake visit.
o DMAS offers a web-based Internet option (ARS) to access information regarding Medicaid or FAMIS eligibility. This website portal can be helpful in verifying the accuracy of the Medicaid/FAMIS number. The website portal address to use to enroll for access to this system is https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderLogin. Click on Provider Resources, then click on Automated Response System (ARS).
· Explain, complete and obtain parent and service coordinator signatures on the Initial Early Intervention Service Coordination Plan. This form is required for children with Medicaid/FAMIS and is strongly recommended for children who are potentially eligible for Medicaid/FAMIS (since Medicaid can be billed retroactively for service coordination if the child receives Medicaid/FAMIS that is retroactive). Local systems have the option to use the Initial Early Intervention Service Coordination Plan with other families as well. The Initial Early Intervention Service Coordination Plan ends when the child is found ineligible for Part C, the IFSP is signed, or 90 calendar days from the date of intake, whichever comes first, with billing not to exceed three calendar months.
· Document in the contact note for the intake visit the family’s preferred method of contact (face to face, phone or email) for the service coordination family contacts that are required every three months.
Note: Service coordination for children with Medicaid/FAMIS is reimbursed through the EI TCM Program. While the legislative terminology for this service is “case management,” it is referred to as “service coordination” in the Infant & Toddler Connection of Virginia.
i. Ask the family about the child’s race/ethnicity using the federally-required 2-part question:
· Is your child Hispanic/Latino?
· From which of the following racial groups is your child? – American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; or White?
Document the family’s response for entry into ITOTS.
· If the family states that they do not belong to one of the given racial groups and states their race as something other than one of the given categories, then record in the contact note or on an intake form the race stated by the family. Based on the race stated by the family, enter the appropriate race category into ITOTS.
· If the family states more than one race for their child, then all races stated must be recorded and reflected in ITOTS.
3. Review the available medical and other records to determine whether those records potentially establish eligibility by documenting, without the need for any additional information, a diagnosed physical or mental condition with a high probability of resulting in developmental delay, developmental delay or atypical development that meets Virginia’s eligibility criteria.
a. If the records document a diagnosed condition (other than an endocrine disorder or a hemoglobinopathy), then complete and sign the Eligibility Determination Form, indicating on the form that eligibility was established by records. In order for a child to be determined eligible based on a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay, there must be documentation that the condition has been diagnosed by a professional qualified to make the diagnosis. Please note that not all disorders within the categories of endocrine disorders and hemoglobinopathy have a high probability of resulting in developmental delay for all children. Therefore, with these diagnoses the documentation from the physician would need to specifically indicate that this condition has a high probability of resulting in delay for this child in order for the service coordinator to establish eligibility based on the records. Otherwise, the eligibility determination practices described in Chapter 5 must be used to evaluate the child’s eligibility.
b. If the records potentially document a developmental delay or atypical development, then coordinate with one individual who is certified as an Early Intervention Professional to review the record and determine whether it establishes eligibility. If the records are found to establish eligibility, then ensure the individual making that determination completes and signs the Eligibility Determination Form, indicating on the form that eligibility was established by records.
c. When eligibility is established by records, the eligibility determination process described below is not necessary and the family moves directly to the assessment for service planning, with parent consent.
4. Unless eligibility is established by records (as described in #3 above), gather information about the child’s development, his health history and his medical home information. Some of this information may have been gathered during the referral call or during the call to schedule the intake visit. In that case, use the intake visit to document any additional information needed for eligibility determination.
a. Begin a conversation with the family that lets you get to know the child and his family and their activities, and that will be used for the purpose of eligibility determination. If the child is found eligible, this information will also be helpful in completing the family assessment and for IFSP development. Conversation starters may include, but are not limited to, the following:
· Tell me about your family - who is in your family.
· Who are the other caregivers for Johnny, e.g., extended family, child care providers, etc.
· Tell me about the places your child and family spend time.
· What is a typical day like for your child and family?
· Tell me about your routines/activities. Which routines/activities are going well and which are not?
· What other activities would you like your child and family to participate in?
· What activities really interest your child, and which ones interest you to do with your child?
This list of suggested conversation starters is not presented in any particular order, and there is no requirement that they be worded as written.
b. Ensure the following eligibility determination screenings activities have been or are conducted. When conducted after referral to the Infant & Toddler Connection System, these screeningsactivities may be conducted by any certified Early Intervention Professional, Early Intervention Specialist or Early Intervention Case Manager trained to conduct the screening activity.
· Hearing and vision screening, with the Virginia Part C Hearing Screening and Virginia Part C Vision Screening forms completed.
1) Parent consent for hearing and vision screening may be documented on the Notice and Consent to Determine Eligibility form or on the Notice and Consent for Assessment for Service Planning form depending on the timing of the hearing and vision screening.
2) If there is sufficient information from other sources (records, information from family, provider observations, etc.) for the eligibility determination team to find the child eligible child has a diagnosed condition or an obvious delay or atypical development that will make the child eligible, then it is not necessary to complete the hearing and vision screening prior to eligibility determination. Under these circumstances, the hearing and vision screening may be completed as part of the assessment for service planning instead.
3) The Virginia Part C Hearing Screening and Virginia Part C Vision Screening may be conducted by any practitioner, including service coordinators, trained to conduct the screening.
4) If the family gives consent for hearing and vision screening on the Notice and Consent to Determine Eligibility form, the family may later agree to wait and complete the hearing and vision screening at the assessment for service planning, as long as their child has a diagnosed condition or an obvious delay or atypical development that will make the child eligible and as long as the decision to wait is documented in a contact note.
5) No child may be found ineligible for Part C without having the hearing and vision screenings completed.
· An evaluation of the child’s developmentmental screening using a screening tool unless there is (1) a diagnosed physical or mental condition with a high probability of resulting in developmental delay, (2) documented developmental delay or atypical development, or (3) the child has already received a developmental assessment or screening prior to referral.
1) The developmental screening tool may be conducted completed by practitioners certified as early intervention professionals and by those certified as early intervention specialists or early intervention case managers who have been trained to conduct screening use the screening tool.
2) For those children who must receive a developmental screening using a tool (those who do not fall into one of the three exceptions listed above), iIt is acceptable to firstuse the screening tool to first look at in the area of the suspected delay or atypical development. If screening results in that area(s) indicates the child will be eligible for Part C, then it is not necessary to screen continue using the tool for in the remaining areas of development. Otherwise, the tool must be used to examine child must be screened in all areas of development. In either case, the provider using the tool conducting the screening must actually see the child in order to complete the screening tool.
3) No child may be found ineligible for Part C without having a developmental screening the use of a screening tool completed in all areas of development.
4) The following comprehensive developmental screening tools are strongly recommended for use in the Infant & Toddler Connection of Virginia: Parents’ Evaluation of Developmental Status (PEDS), Ages and Stages Questionnaire (ASQ), and Bayley Infant Neurodevelopmental Screen (BINS). These recommendations are based on the review of research and resulting recommendations presented in “Pediatric Developmental Screening: Understanding and Selecting Screening Instruments” (2008). This manual can be accessed at http://commonwealthfund.org/Content/Publications/Fund-Manuals/2008/Feb/Pediatric-Developmental-Screening--Understanding-and-Selecting-Screening-Instruments.aspx.